Quote:So fix the law. Don't throw the baby out with the bath water, fix the law. The benefits to society by insuring the uninsureable and the otherwise uninsured outweigh your personal heath care management plan.

@GirlyMan, here's a serious question, that I can't get anybody to answer. Maybe you will.

Remember health care in the US a long time ago was a free market system where patients selected and paid their doctors, who competed to offer the best service at the best price. There were thousands of charity hospitals providing free care to the poor, funded by charitable donations from those better off.

Consider what the US government has done to change health care, but, since we're desensitized to these changes, let's imagine that we were going to make the same changes to automobile care.

First, the government passes laws to fundamentally change the system so that car insurance no longer covers the rare, expensive accidents, but handles every aspect of car repair and maintenance, and the government makes it so that you don't even pick your car insurance company anymore. Your boss does. So, when you want gas or a car wash, you go to the car insurance company which your boss picked, and they will give you a list of gas stations you can go to, and they will pay the gas station, building the cost into your car insurance premiums, with a markup, of course. (This is what the US did to health care during WWII when they fixed wages to curb inflation). Next, the government decides everybody needs access to car care, so they order repairshops to provide repair services to everyone regardless of whether or not you have insurance, or can pay the bill. But the government doesn't regulate the prices the repairshops can charge, so, when poor people without insurance go to get their car repaired, they get a bill that's 10x higher than what the wealthier customers with insurance pay for the same service. And the bills get sent to debt collectors that garnish wages and ruin your credit report, and the #1 cause of bankruptcy in the US becomes these car repair bills. The government then allows car companies to patent general basic concepts, as well as things they observe in nature. So, only one company is allowed to use rubber in their tires, only one other company can use wood on their dash, etc. One company can patent round tail-lights, another square tail-lights, etc. And these car companies sue each other non-stop. Plus, the courts allow anybody to sue any car repair company anytime your car doesn't work, and juries award millions in damages. So Americans start going to Mexico and Canada to get their cars repaired, so the US orders them arrested at the border. Now, a lot of people simply opt out of the system and stop driving (just like I opted out of the US medical system and spend most of my time abroad where there's plenty of good, affordable care). So then the government promises to fix the problem, but it's actually the car insurance companies who end up writing the legislation, which then mandate that everybody needs to buy US car insurance, even if you don't have a car or don't live in the US.

Serious question, what do you think would happen to the state of car repair in the US? And so then if somebody says the solution is to have the government get MORE involved in car repair, what would you say? Given that this is exactly what we've done to health care, is it any surprise that health care got messed up the same way?

I will grant you that some countries' governments create systems that do provide good universal healthcare, such as most Western European countries and Canada. But they typically accomplish this by either (a) having governments that aren't so politically divided, are more transparent and accountable, and everybody works together, or (b) like in Canada, defer to the local governments.

The problem is how to fix it. The sad reality is that once the government ordered all hospitals to provide car regardless of the patient's ability to pay, this put an end to all the thousands of charity hospitals that used to provide free care for the poor and elderly. So, there's no way to go back because if the government just pulled out the poor and elderly would be destitute now that the charitable support structure has been dismantled. Therefore, I don't have any good ideas for how we can fix the problem since it's just so badly screwed up now. But I'm skeptical that having the government pass MORE laws is going to make things better.

I think it's a false analogy, Frank. Everyone will not need car care. My mom don't have a car but she did need an aortic valve replacement. Virtually everyone will need health care at some point and the uninsured showing up at the ER is not only inefficient, the rest of us end up paying for it. The private sector is still providing the insurance and health care under the ACA, the Government is just regulating it and ensuring that everyone has access to the same coverage. Except for the exceptional cases like yours. The law does fuck you. I think if they opened up the catastrophic coverage option to everyone, not just those under 30 or who can't afford anything else, you could still stick with your current strategy. You could also elect to pay the penalty but given your posts, 2.5% of your income would probably leave an awfully nasty taste in your mouth. I know it would mine.

@GirlyMan, I agree that health care is more universal than car care. But I don't see how that's relevant to the analogy. My assertion is that part of the reason health care is so messed up in the US is that the customer doesn't get to pick who performs the service; the insurance company does, and the employer picks the insurance company. I pointed that pretty much any service will get screwed up when that happens, whether it's car care or health car. How does the fact that that more people need health care change the situation? Go to medical facilities which do NOT accept insurance, places where the patient picks his own provider, and the providers have to vigorously compete to offer the best service at the best price. There you find people get great care at a good price. Most of these facilities are outside the US, but there are some doctors in the US as well that do not accept insurance and have to appeal to patient's directly. One obvious example are cosmetic surgeons, since they're not covered by insurance. They advertise relatively low-cost specials, heck you can even get things like 'laser face lifts' on groupon for $200. But comparable procedure that are handled through the insurance system, like laser cancer removal, cost much, much more. And the level of innovation is much more rapid in those direct-to-consumer sectors of health care. Also, don't forget veterinary doctors go through almost as much education as human doctors, and our pets generally get the same procedures as humans (chemotherapy for cancer, hip replacement, etc.) and they use the take the same drugs and medicine. But the costs are 1/10 as much because vets, like cosmetic surgeons, compete directly for your business.

Do you not agree that in any industry, be it health care or something else, customers get the best service at the best price when the providers have to compete for the customers' business?

(06-10-2013 03:04 PM)frankksj Wrote: @GirlyMan, I agree that health care is more universal than car care. But I don't see how that's relevant to the analogy. My assertion is that part of the reason health care is so messed up in the US is that the customer doesn't get to pick who performs the service; the insurance company does, and the employer picks the insurance company. I pointed that pretty much any service will get screwed up when that happens, whether it's car care or health car. How does the fact that that more people need health care change the situation? Go to medical facilities which do NOT accept insurance, places where the patient picks his own provider, and the providers have to vigorously compete to offer the best service at the best price. There you find people get great care at a good price. Most of these facilities are outside the US, but there are some doctors in the US as well that do not accept insurance and have to appeal to patient's directly. One obvious example are cosmetic surgeons, since they're not covered by insurance. They advertise relatively low-cost specials, heck you can even get things like 'laser face lifts' on groupon for $200. But comparable procedure that are handled through the insurance system, like laser cancer removal, cost much, much more. And the level of innovation is much more rapid in those direct-to-consumer sectors of health care. Also, don't forget veterinary doctors go through almost as much education as human doctors, and our pets generally get the same procedures as humans (chemotherapy for cancer, hip replacement, etc.) and they use the take the same drugs and medicine. But the costs are 1/10 as much because vets, like cosmetic surgeons, compete directly for your business.

Do you not agree that in any industry, be it health care or something else, customers get the best service at the best price when the providers have to compete for the customers' business?

Most of this is no change. Many employers offer more than one plan, most plans allow doctor choice, many people are self-employed, and so on. None of this changes appreciably under the ACA.

I get that you're butt-hurt over your plan. The only changes for me are lower cost and more doctor choice. So if I generalize like you do, the ACA is a giant win.

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(06-10-2013 03:04 PM)frankksj Wrote: Do you not agree that in any industry, be it health care or something else, customers get the best service at the best price when the providers have to compete for the customers' business?

Yes, I agree. But it's the insurance companies that are the ones vying for my business not my health practitioners. My employer, the Gumbymint, don't decide what insurance I get they just ensure that all of my options meet a minimum standard of coverage. All my doctors accept every insurance option available to me. And previously they never required me to get insurance, they just loaded it with a serious disincentive that if I didn't have it for at least the last 5 years before I retired I'd lose the sweetheart deal after retirement. That has changed with the individual mandate but I don't know any Gumbymint employee who has elected not to take the sweetheart deal anyway (well except for Ted Cruz, 'cause his wife's got serious platinum++ coverage from Goldman Sachs). I realize that I'm in an unusual position 'cause I'm covered by FEHB, but it's kinda like one of the reasons I elected to go into public service in the first place. And the ACA looks to me like a universal expansion of the FEHB. The only really controversial piece of it is the individual mandate. But I don't see how it could work without it.

(06-10-2013 03:27 PM)Chas Wrote: Most of this is no change. Many employers offer more than one plan, most plans allow doctor choice, many people are self-employed, and so on. None of this changes appreciably under the ACA.

I get that you're butt-hurt over your plan. The only changes for me are lower cost and more doctor choice. So if I generalize like you do, the ACA is a giant win.

@Chas, I'm not suggesting that the ACA is responsible for the system where the health insurance companies choose what health care is appropriate for patients. This has been going on for decades, and is actually the same in most countries. It traces back to the price and wage controls during WWII.

My point is a more general one, and that is that I think we're so used to the current system we forgot what insurance actually IS. Insurance is a managed risk pool. It's there in case something catastrophic happens. Everybody knows you WILL pay more on average with insurance than without, but we pay MORE because it relieves us of the risk that we're the one who has a disaster. This is the way all insurance works--except health insurance. For routine, scheduled care, like checkups, the insurance company is simply a middle-man that adds no value. They're not reducing risk, since we all know we're going to need the care anyway. They're marking up what is a known, predictable expense, adding a lot of complexity and paperwork in the process, and reducing the patient's choices.

When you have a situation like this, it is NOT free market economics. Free markets are driven by the concept that the one needing the product or service (the consumer) is in the driver's seat and providers are competing for his business. That doesn't happen with health care. While I think the best results come from having a true free market system, I would actually favor having a single payer system (administered at the local level of course, like in Canada) over this one because at least that way if you're forced to participate in the system you do get a vote, and, since it's taxpayer funded, there's no perverse incentive for the government health administrators to kill you off when you get sick. What we have in the US is essentially a single payer system, BUT, the single payer is a small group of private corporations whose primary motive is profit, and who have a perverse incentive to deny people the health care they need and kill off people who get sick in order to maximize their profits. IMO, it's the WORST possible solution--worse than a government-run single-payer system.

What I hate about Obamacare isn't that it created this fucked-up system, it's that it strengthens and shores up this fucked-up system, forcing everyone to be a part of it.

(06-10-2013 04:18 PM)frankksj Wrote: But it's the insurance companies that are the ones vying for my business not my health practitioners.

@Girlyman, afaik most employers don't let the employees pick the insurance company they want to use. Regardless, the insurance company's incentive is to make profit, right? How does the insurance company maximize their profit? So let's say you get some rare disease and the latest treatment is an exotic procedure that costs a fortune. Is it in the insurance company's best interest to give it to you? Surely you agree it's not, right? The insurance company's interests are served by denying you access to the care you need. Of course, it's in the best interest of the both you and the doctor who is offering the life-saving treatment to get you the treatment. If it was between the two of you, you both have an incentive to find a way to get you the treatment. But it's not a decision between the two of you--it's a decision by a company whose interests are served by denying you the treatment you need.

Even if you DO get to pick your insurance company, my point is that having a private, for-profit insurance corporation handle scheduled, routine care is just adding an unnecessary middleman that adds no value, but adds cost and complexity. It's a mistake to use an insurance company, which is a managed risk pool, to pay for routine expenses. We all instinctively understand this, which is why it sounds crazy to do this for car insurance. But we're just used to it for health insurance and don't question it anymore.

(06-10-2013 04:18 PM)frankksj Wrote: What I hate about Obamacare isn't that it created this fucked-up system, it's that it strengthens and shores up this fucked-up system, forcing everyone to be a part of it.

That is a reasonable objection. Much of the cost of our health care is due to the fact that we bear the brunt of pharmacological R&D and the rest of the world just piggybacks on us. I got no idea what to do about that.

(06-10-2013 04:28 PM)frankksj Wrote: @Girlyman, afaik most employers don't let the employees pick the insurance company they want to use. Regardless, the insurance company's incentive is to make profit, right? How does the insurance company maximize their profit? So let's say you get some rare disease and the latest treatment is an exotic procedure that costs a fortune. Is it in the insurance company's best interest to give it to you? Surely you agree it's not, right? The insurance company's interests are served by denying you access to the care you need. Of course, it's in the best interest of the both you and the doctor who is offering the life-saving treatment to get you the treatment. If it was between the two of you, you both have an incentive to find a way to get you the treatment. But it's not a decision between the two of you--it's a decision by a company whose interests are served by denying you the treatment you need.

Even if you DO get to pick your insurance company, my point is that having a private, for-profit insurance corporation handle scheduled, routine care is just adding an unnecessary middleman that adds no value, but adds cost and complexity. It's a mistake to use an insurance company, which is a managed risk pool, to pay for routine expenses. We all instinctively understand this, which is why it sounds crazy to do this for car insurance. But we're just used to it for health insurance and don't question it anymore.

Yes. But you are making the case for Government regulation. Under the ACA insurance companies must now provide preventive care at no cost to the individual. But I agree that other than the catastrophic coverage plans "health care insurance" is now a misnomer and has been for a while. It should be called "subsidized health care".

(06-10-2013 04:31 PM)GirlyMan Wrote: But you are making the case for Government regulation

Yes, although I hate government regulation, I concede that _IF_ the government is going to force you to buy a product from a private, for-profit corporation with no way out, _THEN_ there must be government regulation. My biggest issue then is that _IF_ the government get involved, it honors the rule of law (the Constitution) and does it at the state or local level, so that we have lots of competing systems (even if they are state governments), and a relief-valve if the government implements a bad system (people will move out of the state). The only thing I'm 100% against, is breaking the rule of law and having everything done at the Federal level because, then no matter how fucked up it is, we're going to be stuck with it for a very, very long time, if not forever. 90% of private companies fail because they have a bad model. But with government agencies, even ones that have a terrible model, you just can't get rid of them. They just grow and grow like cancer. Even something like HUD, where even left-wing liberals admit it's destroyed opportunities for inner-city kids and the housing projects are breeding grounds for a vicious cycle of crime and drug addition, even these agencies never go away, but just get bigger each year.

(06-10-2013 04:51 PM)frankksj Wrote: The only thing I'm 100% against, is breaking the rule of law and having everything done at the Federal level because, then no matter how fucked up it is, we're going to be stuck with it for a very, very long time, if not forever.

My State, the Peoples Republic of Commie Bastards Maryland, has set up its own exchange. The Feds ain't involved here. The Teaturd States who have rejected the ACA have basically invited Federal intervention. Fucking idiots.

(06-10-2013 04:51 PM)frankksj Wrote: The only thing I'm 100% against, is breaking the rule of law and having everything done at the Federal level because, then no matter how fucked up it is, we're going to be stuck with it for a very, very long time, if not forever.

My State, the Peoples Republic of Commie Bastards Maryland, has set up its own exchange. The Feds ain't involved here. The Teaturd States who have rejected the ACA have basically invited Federal intervention. Fucking idiots.

No shock there. As much as red stater's love to bitch about taxes and the government they almost always use more federal money than they contribute.

(31-07-2014 04:37 PM)Luminon Wrote: America is full of guns, but they're useless, because nobody has the courage to shoot an IRS agent in self-defense